Provider Demographics
NPI:1760488944
Name:CREMER, JODY DUANE
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:DUANE
Last Name:CREMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 PRECINCT LINE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-4313
Mailing Address - Country:US
Mailing Address - Phone:817-427-1700
Mailing Address - Fax:817-427-1703
Practice Address - Street 1:6505 PRECINCT LINE RD
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-4313
Practice Address - Country:US
Practice Address - Phone:817-427-1700
Practice Address - Fax:817-427-1703
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2011-05-18
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
TX187151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry